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. <br />nCity of Everett <br />Sewer Application and Permit <br />N 0.23223 DATE <br />Service Address <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />Connection By -- <br />Address <br />Phone <br />DESCRIPTION: <br />Lot _ Block <br />Plat <br />Unplatted Descriotinn <br />Type Permit: <br />Remarks: <br />SEE SKETCH ATTACHED <br />r <br />INSPECTION <br />CHART NO.fil <br />" <br />6W <br />Utility Account No. <br />Permit Fee <br />Connection Charge(s) <br />Total Fee <br />Signed <br />Cus,umcr <br />Sewer Disti i-t <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Trunk <br />Lateral <br />Abutting Lot Line <br />N, S, E, W_ <br />Approved By <br />Gry Engineer —�— <br />Issued <br />Inspection By /?'���f%�r�,r.,•a�(I` <br />Date Inspected <br />NO. 23223 I <br />